In the future, doctors may be able to diagnose early Parkinson’s disease (PD) with a colonoscopy, according to a new study recently published in Movement Disorders. In PD, a protein called alpha-synuclein forms abnormal clumps, which can kill the brain’s dopamine-producing neurons. The formation of these clumps, known as Lewy bodies, are considered a pathologic hallmark of the disorder.

Scientists have also detected alpha-synuclein clumps in nerve cells of the colon and skin of people with PD. This discovery led to a theory that PD begins in tissues outside the brain. Can the presence of alpha-synuclein aggregations in colon tissue predict PD development? Researchers at Rush University studied colon biopsy samples from three people with PD, collected by colonoscopy two to five years before the people showed symptoms of PD. They detected alpha- synuclein by staining the protein with dyes and fluorescent molecules.

Results

Alpha-synuclein protein was detected in nerve cells of colon tissue from all three people who later developed symptoms of PD. No alpha-synuclein was detected in colon tissue samples from 23 healthy people without PD.

What Does This Mean for PD

The detection by Dr. Shannon’s team of alpha-synuclein in the colon tissue samples of people who later developed PD, supports a hypothesis that the disease may possibly begin in neurons of the intestinal wall and later spread to the brain. This study is the first to show alpha-synuclein in colon tissue before onset of PD. Currently, diagnosis of Parkinson’s disease depends on the appearance of such cardinal features as tremor, slowed movement, rigidity and gait problems. The clinical diagnosis can be difficult early in the disease, and as many as 10 percent to 20 percent of patients may be misdiagnosed. Studies have shown that by the time primary symptoms appear, many patients with Parkinson’s disease will have lost 60 percent to 80 percent or more of dopamine-producing cells in the brain. If the findings from this very small study are replicated in studies involving larger samples, it may be possible one day to use colonoscopy to predict who will develop PD. Because doctors already recommend that people age 50 and older have a colonoscopy every few years, it would be relatively easy to test colon tissue biopsies for the alpha-synuclein protein. Alternatively, colonic tissue could be collected using flexible sigmoidoscopy, a technique that, unlike colonoscopy, requires no colon cleansing preparation or sedation and can be performed in 10 minutes. Early detection of PD would help facilitate a search for a cure, or for interventions that slow the disease. But first, it will be important to confirm the results in larger populations of people with and without PD.

Scientists at the National Institute on Aging have found evidence suggesting fasting can reduce the worst symptoms of movement disorders such as Parkinson’s disease and Alzheimer’s. With the correct timing and right amount of calorie cutting, one may be able to live more comfortably with their neurological disorders. The study found that those who went two days while only consuming 500 calories reported being able to manage their symptoms better. Past studies found calorie cutting can greatly increase the lifespan of mice, though human studies have yet to be thoroughly done. The researchers believe that the chemicals the body produces when hungry can counteract the impact of movement disorders. The scientists at the National institute on Aging plan to perform further testing using MRI scans and other techniques.

Read this article on fasting effects on movement disorders on Guardian.co.uk

The results are out on a new drug called teriflunomide that has been shown to slow the progression of multiple sclerosis, specifically slowing the time to a first relapse, and has also been approved to treat rheumatoid arthritis. A study, published in the New England Journal of Medicine, (showed) that the drug performed superior to placebo and has a few definite advantages when compared to similar drugs such as fingolimod. According to the lead author of the study, Paul O’Connor, MD, “it’s safe, and it’s oral, it’s easier to use than fingolimod… and can be washed out of the patient within days — for example, if the patient becomes pregnant,” as opposed to the 45 days fingolimod requires. The drug reduced disease progression by 30 percent and produced no deaths or opportunistic infections.

Its most common side effects include diarrhea, nausea, and hair thinning. There is also some concern about the drug’s interaction with the immune system. Because it inhibits T cell activity, there is a possibility of infection. However, due to the drug’s ability to be washed from the body so quickly, the safety of the drug is improved and as previously mentioned, no infections have yet been observed.

Ultimately it will be beneficial for patients to have more treatment options on the table because everyone’s body reacts differently and this may work better for some than what is currently available. For further reading, visit Neurology Today.

Background on the CDE Project

In 2011, the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, released the Parkinson’s disease Common Data Elements (CDEs), and the Institute is pleased to announce that the development of CDEs for Huntington’s disease (HD) is now complete.

The CDE Project is aimed at developing content standards that enable clinical investigators to systematically collect, analyze, and share data across clinical studies. Study start-up can be a time-consuming effort, and often investigators develop their own data collection tools. The availability of CDEs will facilitate the initiation of a study, promote data collection in a consistent format, and enable comparisons between studies. Twelve disorders are currently included in the CDE Project, with PD, HD, and Friedreich’s ataxia being of particular interest to the Movement Disorders community.

Huntington’s Disease CDEs

Process and products

For the HD CDEs, an external Working Group of nearly 60 HD experts world-wide was assembled and divided into 11 Subgroups, with Julie Stout, PhD (Monash University, Melbourne, Australia) and Ira Shoulson, MD (Georgetown University, Washington, DC) serving as the Working Group Chairs.

A listing of the HD CDE Working Group Members is available on the HD CDE website.

The HD Subgroups met over a 15-month period to develop their recommendations. Following an internal Working Group review period, the recommendations were posted for public comment. The feedback was incorporated, and the HD CDEs are now publicly available for use.

On the website, you will find a listing of standardized instruments with recommendations regarding their use. There is a catalog of HD CDEs, template case report forms, and data dictionaries. Subgroups gave particular attention to differences in recommendations for manifest versus pre-manifest HD.

It was recommended that the following instruments be collecting in all HD studies:

In addition, as addressed in detail on the website, several other instruments can be considered for use in various types of HD studies.

How to find the CDEs

1. Search the internet for “NINDS HD CDE”

2. Click “Tools” to access the CDE Catalog, CRF Library, and Form Builder

Impact of the CDEs

Rapid adoption of the HD CDEs will translate into improved efficiencies across clinical research activities. The CDEs provide a library of assessments and measurement standards that have been vetted by experts in the field, which will make it increasingly possible to choose measures with confidence even for aspects of HD that are outside of a given investigator’s direct areas of expertise. The longer-term benefits of using the HD CDEs will include the ability to create large datasets by combining several studies that share common elements. Such large datasets are required, for example, to be able to detect the very smallest effects that HD has in people many years before onset, and to examine more subtle genetic variability. The HD CDEs will provide investigators, both experienced and new to field, with a valuable research tool to access and make use of informative data elements that have stood the test of time in assessing individuals affected by HD.

References

• Huntington Study Group. The Unified Huntington’s Disease Rating Scale: Reliability and Consistency. Mov Dis, 1996; 11:136–142.
• Craufurd D, Thompson J, Snowden JS. Behavioural changes in Huntington’s disease: The Problem Behaviours Assessment. Neuropsychiatry, Neuropsychology and Behavioural Neurology, 2001; 14(4):219–226.
• Rowe KC, et al. Self-paced timing detects and tracks change in prodromal Huntington disease. Neuropsychology, 2010; 24(4):435–442.
• Bechtel, N., Scahill, R. I., Rosas, H. D., Acharya, van den Bogaard, S.J.A., Jauffret, C., Say, M.J., Sturrock, A., Johnson, H., Onorato, C.E., Salat, D.H., Durr, A., Leavitt, B.R., Roos, R.A.C., Landwehrmeyer, B., Langbehn, D. R., Stout, J.C., Tabrizi, S.J., Reilmann, R. Tapping linked to function and structure in premanifest and symptomatic Huntington’s disease. Neurology, 2010; 75:2150–2160.
• Stroop, J. R. Studies of interference in serial verbal reactions. Journal of Experimental Psychology: General, 1935; 18:643–662.
• Smith A. Symbol digit modalities test: Manual. Los Angeles; Western Psychological Services; 1982.
• Fals-Stewart W. An Interrater Reliability Study of the Trail Making Test (Parts A and B). Perceptual and Motor Skills, 1992; 74:39–42.
• Paulsen, J. S., Wang, C., Duff, K., Barker, R., Nance, M., Beglinger, L. et al. Challenges assessing clinical endpoints in early Huntington disease. Mov Disord, 2010; 25(15):2595–2603.
• Marder, K., et al., Rate of functional decline in Huntington’s disease. Huntington Study Group. Neurology, 2000; 54(2):452–8

This article is from the National Institute of Neurological Disorders and Stroke

Wendy R. Galpern, MD, PhD, NINDS; Julie C. Stout, PhD, Monash University; Ira Shoulson, MD, Georgetown University

Most medications for Parkinson’s disease address the hallmark issue of dopamine deficiency–most specifically the drugs levodopa and carbidopa. However, because treatments do not consistently control PD symptoms, “off time” occurs when the beneficial effects of the drug wear off and symptoms begin to return. While off time in Parkinson’s patients can be difficult to manage, there are improvements in the works. A trial found that levodopa-carbidopa intestinal gel (LCIG) reduced off time by an average of two hours per day when compared to standard oral levodopa-carbidopa.

A key element of the positive results is the mechanism by which this treatment works. “’Off’ time was reduced because the infusion of levodopa-carbidopa intestinal gel (LCIG) helps to deliver levodopa-carbidopa continuously, thereby avoiding the fluctuating levels that occur with standard oral levodopa-carbidopa therapy and that are thought to contribute to the development of wearing off,” said study author C. Warren Olanow, MD, Professor of Neurology and Neuroscience at the Mount Sinai School of Medicine in New York and a Fellow of the American Academy of Neurology.

Recently presented at the American Academy of Neurology’s 64th Annual Meeting in New Orleans, this study offers progress towards improving the quality of life for many PD patients. To read more about it, read the full press release at the American Academy of Neurology.

There are always new treatments for Parkinson’s disease on the horizon and with so many minds working on this, developments are inevitable. A particular drug, dipraglurant, has shown promising results when tested for the treatment of levodopa-induced dyskinesia (PD-LID). The approach is to block a specific glutamate receptor that has previously been linked to excess glutamate activity in those with Parkinson’s disease. A recent trial of 72 patients studied aspects such as safety and the results were reportedly positive. According to a recent press release, “dipraglurant appears to reduce dystonia severity in addition to chorea, the two major LID components.”

Since no drug has yet been approved by the FDA to treat dyskinesia, progress here is welcomed. For more details, see a summary at Addex Therapeutics.

Prior to the decline in cognitive skills that is often the first symptom of Alzheimer’s, it is widely believed that beta-amyloid plaque builds up in the brain. Pfizer Inc has researched a drug, bapineuzumab, that they believe is the best treatment for Alzheimer’s because it is an antibody designed to bind to and clear this plaque from the brain. Bapineuzumab will be used early in the disease process with the aim of slowing Alzheimer’s degenerative effects. Although phase III data had not yet been released, according to Pfizer Inc’s Mikael Dolsten, “this is so far the best chance the industry has for disease modification in Alzheimer’s."

Although these results seem promising, mixed results were observed among patients in smaller, earlier studies such as brain swelling seen in those that received a higher dose. This brain swelling can lead to other effects such as headaches, weakness, memory loss, and hallucinations. In addition to mixed results, the drug may not turn out to be a viable treatment upon further scrutiny because it treats patients that already have developed symptoms and therefore they may have potentially permanent damage inflicted on brain tissue and the neurons themselves.

One study looked at possible trends around amyloid-related imaging abnormalities (ARIA) that seem to be treatment-related:

The authors aimed to investigate the incidence of ARIA during treatment with bapineuzumab. They conducted a systematic, central review of all MRI data from studies (two phase 2 and one ongoing open label) to assess the incidence of ARIA during bapineuzumab treatment, and their associated risk factors and clinical characteristics. The results of the analysis found that ARIA was detected in 36 of 210 (17%) patients treated with bapineuzumab and most cases were clinically silent. The authors conclude, “The increased risk of ARIA among APOE ɛ4 carriers, its association with high bapineuzumab dose, and its timecourse in relation to dosing suggest an association between ARIA and alterations in vascular amyloid burden.” They note that their findings have important implications for elucidation of the mechanisms underlying ARIA and warrant the close monitoring of ARIA in the development of anti-amyloid therapies for Alzheimer’s disease.

Despite these concerns, however, there are indications that the drug may be safer than previously thought:

New longer-term safety data on bapineuzumab suggest that although the brain swelling may be more common than first reported, the risk appears to decline the longer a person is taking the drug. Also, the brain swelling is often mild, causing no symptoms, according to the research presented here at the Alzheimer’s Association International Conference. In animal research and early human studies, bapineuzumab appeared to work just as it was supposed to. But as the side effect of brain swelling surfaced – formerly called vascular edema and now known as amyloid-related imaging abnormalities, or ARIA – so did safety concerns. Encouraging. Dolsten predicts that within the next five years it will be possible for Alzheimer’s patients to receive bapineuzumab treatment, used at earlier stages of the disease for the most beneficial results. Phase III data is expected to be released in the second half of this year.

For further reading, visit The Huffington Post, WebMD, or NELM.

ProteoTech, Inc., a privately held biotechnology company, has entered into a drug development agreement with GlaxoSmithKline R&D Company Limited to collaborate on ProteoTech’s small molecule technology platform against misfolded proteins to specifically advance work on its alpha-synuclein therapeutic program for the treatment of Parkinson’s disease and other synucleinopathies.

Steve Runnels, CEO of ProteoTech, stated “We are pleased to be working with GlaxoSmithKline on the identification and optimization of new therapeutic compounds for Parkinson’s and other synucleinopathies, such as Lewy Body Dementia and Multiple System Atrophy. We are excited to be working with this leading pharmaceutical company on this important project which further validates ProteoTech’s small molecule approach for developing therapies against diseases caused by misfolded proteins.”

Initial support for ProteoTech’s alpha-synuclein therapeutic research program was funded over a four- year period by the Michael J. Fox Foundation for Parkinson’s Research (MJFF). Todd Sherer, PhD, the Chief Executive Officer of the MJFF commented, “We have followed ProteoTech’s success on this therapeutic development program over the years and are extremely pleased to see this collaboration between them and GlaxoSmithKline to accelerate the development of a potential disease modifying treatment for this debilitating disease. This is what we all hoped to see when ProteoTech was initially granted the LEAPS award from our Foundation.”

About ProteoTech: ProteoTech is a private drug development company located in the Seattle, WA area (Kirkland, WA), and is focused on targeting amyloid diseases caused by protein misfolding. Besides the Company’s SynuclereTM program, in late pre-clinical development for the treatment of Parkinson’s disease, ProteoTech is developing Exebryl–1® for the treatment of diseases caused by beta-amyloid protein and tau protein aggregates and fibrils; and is in early human clinical studies with SystebrylTM for the treatment of Systemic AA Amyloidosis. The Company is also in late pre-clinical development for a novel small peptide (PepticlereTM) for the treatment of Alzheimer’s disease beta-amyloid protein aggregates. For more information please see the Company web site at Proteotech.com.

Impax, the Hayward and technology-based generic pharmaceuticals company, in collaboration with GlaxoSmithKline, announced their new treatment for idiopathic Parkinson’s disease on December 21st, 2011. It is currently being reviewed by the U.S. Food and Drug Administration (FDA). Titled “IPX066,” this extended release capsule “is intended to maintain consistent plasma concentration of levodopa for a longer duration versus immediate release levodopa, which may have an impact on fluctuations in clinical response.”

IPX066 has been researched for three and a half years “through multiple clinical studies of efficacy and safety.” IPX066 has been studied in early and advanced U.S. and European Parkinson’s patients.

Caribdopa/levodopa, also known as Sinemet, was one of the first major drugs used to treat Parkinson’s disease and is currently widely used. This drug is converted to dopamine voa a natural enzyme to reduce the symptoms of Parkinson’s disease with less side-effects.

Learn more about Parkinson’s disease

Read this press release at ImpaxLabs.com.

A new diet, recommended by the American Diabetes Association, called “Consistent Carbohydrates Diet” or “CCD” focuses on reducing the carbohydrates one consumes in hopes that it will help control their diabetes. The experts now believe that carbohydrates are directly related to blood glucose levels. Monitoring the carbohydrates you consume can give you better glycemic control.

How a Physician Orders the Diet

Consistent-carbohydrate meal plan: The meal plan incorporates consistent carbohydrate intake (+15g of carbohydrate per meal or snack), fat intake modifications, and consistent timing of meals and snacks, not specific energy levels. The plan provides four carbohydrate selections (60 grams) at breakfast and five carbohydrate selections (75 grams) at lunch and dinner with the remaining selections from vegetables, lean meats, and appropriate fats. This diet is the standard hospital meal plan for people with diabetes and does not include in-between or evening snacks. The meal plan provides 1,500 to 1,800 kcal/day, with approximately 50% of the energy from carbohydrate, 20% from protein, and 30% from fat (<7% saturated and trans fat combined) (2-4).

Further reading

• Your diabetes diet: Exchange lists
• Glycemic index
• Consistent Carbohydrate Diet - LiveStrong
• A Consistent Carbohydrate Diet for Geriatrics
• The Consistent Carbohydrate Diet for Diabetics

The Screenings will start the 1st Saturday of every month starting January 7, 2012 for $25.

Along with a screening by a licensed physical therapist to assess ones vestibular system and dynamic balance, there will be foot analysis and computerized posturography analysis for each person to take to their MD for further evaluation and diagnostic assistance. This is not covered by insurance and only cash or credit card is accepted.

More information

Call 626-593-2283 To Reserve your Space Today!

Location: 1030 South Arroyo Parkway, Suite #109, Pasadena, CA 91105

More information at ArroyoPT.com.

This news is a bit outdated, but it’s always great to see Michael J. Fox and several large companies putting their minds together to help those with Movement Disorders. You may know Michael J. Fox from the Back To The Future movies. This famous movie from 1985 featured some custom futuristic shoes that the character Marty McFly (played by Michael J. Fox) wore.

Michael J. Fox was diagnosed with Parkinson’s Disease in 1990 and established The Michael J. Fox Foundation in 2000. The organization has invested nearly $179 million in research for Movement Disorders. The Michael J. Fox Foundation has been very successful because of their unique ventures such as this recent auction of movie memorabilia.

Read more about the Nike Mag Aution at VentureBeat
Visit the Nike Mag auction on Ebay.com

DATScan has been able to detect the difference between Essential Tremor & Parkinson's Disease in clinical trials.

GE Healthcare recently announced DATScan, ioflupane iodine–123 injection, a contrast agent for use with single-photon emission computed tomography (SPECT) for detecting dopamine transporters (DaT) in suspected parkinsonian syndromes.

The DaT visualization was created to help differentiate essential tremor and drug induced parkinsonism from tremor due to parkinsonian syndromes (including idiopathic Parkinson’s disease, multiple-system atrophy, and progressive supranuclear palsy, as an adjunct to other diagnostic modalities). These new SPECT scans show abnormal distribution of DaT in parkinsonian syndromes but are normal in other conditions, such as essential tremor and Alzheimer’s disease.

New Diagnostic Adjunct

Currently, movement disorders are diagnosed with clinical and laboratory tests as well as neuropsychological evaluations, "which are not conclusive and may lead to misdiagnosis.

FDA Advisory Panel

"This might make a real difference in 5% of patients seen by movement disorders specialists and 15% of patients seen by general practitioners, and that's an important number of patients," committee member Nathan Fountain, MD, associate professor of neurology at the University of Virginia, Charlottesville.

"There are many circumstances I can think of and imagine where this could be a benefit, and the risks are very low," said Karl Kierburtz, MD, MPH, committee member and professor of neurology and community and preventive medicine at the University of Rochester, New York.

Dr. Kierburtz noted that in many instances DaTscan could help improve the diagnostic accuracy by clinicians and decrease some of the problems associated with other means of differential diagnosis — such as medication challenges, which often work poorly in the elderly or patients with dementia.

Committee members emphasized that DaTscan was not suitable for screening or prognosis on its own. "We don't want to make this the gold standard for diagnosing Parkinson's disease.

Watch a promotional video for DATScan on GE Healthcare's website.

Safety Concerns and Practical Issues

Joel Perlmutter, MD, professor of neurology at Washington University School of Medicine, St. Louis, Missouri, said that after reviewing the scientific literature, he did not think that DaTscan was cost-effective. Between the cost of DaTscan ($1500 per scan) and a month’s trial of carbidopa or levodopa for a patient with possible PD ($150), the price can easily become unbearable. Joel said “it wouldn’t change how I would treat a patient.”

There are always issues with scans that require an active substance, such as iodine, into the body since some individuals have known sensitivities. GE Healthcare gave the following warning in their release notes: “To decrease thyroid accumulation of I–123, block the thyroid gland at least 1 hour before administration of DaTscan; failure to do so may increase the long term risk for thyroid neoplasia.”

GE has also stated that in clinical trials, adverse reactions such as headache, nausea, vertigo, dry mouth, and mild to moderate dizziness were reported. Hypersensitive and painful reactions in the injection site have also been documented.

Overall, the DATScan machine is promising. It’s new technology, but I believe it will soon be a valuable tool for diagnosing Parkinson’s Disease and Essential Tremor.

Learn more about DATscans at Medscape
Visit GE Healthcare to read/view DATScan promotional material

Welcome to the new official Southern California Movement Disorders website! Here is a breakdown of what this site has to offer:

About SoCalMDS

About — Introduction to Southern California Movement Disorders; get directions, contact information, and learn about our services.
Contact Us — Get in touch with Dr. Jerome P. Lisk M.D. and his staff. Email, Tweet, or send us a Facebook message.
Our Physicians — Learn about our excellent team of highly trained and well educated movement disorder specialists and staff.
Treatment — Read about the treatments Southern California Movement Disorder Specialists offers. Understand our approach to managing movement disorders and the treatments we prescribe to help our patients.

Patient Forms

Referral Form — Fill out this digital form so we can contact your other doctors and pharmacies and send them a progress report.
Patient Form — Download this PDF form and fill it in at your leisure if you are a new or returning patient. Bring the filled out form into our office.

Learn about Movement Disorders

Dystonia — Learn about the neurological movement disorder Dystonia. Visit these websites to learn how to support and manage Dystonia.
Parkinson's Disease — Learn about the neurological movement disorder Parkinson's Disease. Visit these websites to learn how to support and manage Parkinson's Disease.
Huntington's Disease — Learn about the neurological movement disorder Huntington's Disease. Visit these websites to learn how to support and manage Huntington's Disease.
Restless Legs Syndrome— Learn about Restless Leg Syndrome. Visit these websites to learn how to support and manage Restless Leg Syndrome.
Tremor — Learn about the neurological movement disorder Tremor. Visit these websites to learn how to support and manage Essential, Cerebellar, Dystonic, Orthostatic, Parkinsonian, and Rubral Tremor.
Other — Learn about other neurological movement disorders. Visit these websites to learn how to support and manage other common neurological disorders.

Additional Resources

Neurology News — The Southern California Movement Disorder Specialist's official blog. Read up on the latest neurology and movement disorder-related news.
Support Groups — Visit these popular and reputable movement disorder support groups for help or to help. They are always in need of donations and volunteers.
Trials & Research — The latest movement disorder research, scientific studies, and academic trials from reputable journals and online databases.
Recommended Products — Products we often recommend to our patients. Books, equipment, and other goods provided by Amazon.com.

Thanks for stopping by, and we hope SoCalMDS.com becomes your favorite source for neurology and movement disorder news!

There is a new technology called "DAT Scan" that can tell the difference between Parkinsonism and Essential Tremor.The description is very good in Wikipedia and GE Health Care and National Parkinson's Foundation Website.

This is an excerpt from GE Health Care's website about their new product:

DaTscan is an imaging drug that will be injected into the bloodstream to help your doctor assess a chemical in your brain called dopamine. A special device, called a gamma camera, will take pictures of your brain. These pictures and a report will be sent to your doctor, who can discuss the test results with you. The DaTscan results may help determine if the symptoms you are experiencing are the result of a Parkinsonian syndrome.

DaTscan is for adult patients who have signs or symptoms of Parkinsonian syndromes, such as shaking or stiffness. DaTscan is available only with a prescription from your doctor, and only your doctor can decide if this test is right for you.

Here is an excerpt from Wikipedia about the new drug/technology:

Ioflupane is the International Nonproprietary Name of a phenyltropane compound which is a neuro-imaging radiopharmaceutical drug, used by nuclear medicine physicians for the diagnosis of Parkinson's disease and the differential diagnosis of Parkinson's disease over other disorders presenting similar symptoms. It is injected into a patient and viewed with a gamma camera in order to acquire SPECT images of the brain with particular respect to the striatum, a subcortical region of the basal ganglia. The drug is sold under the tradename DaTSCAN and is manufactured by GE Healthcare, formerly Amersham plc. It is not marketed outside of Europe and the United States.

 

Learn more about DaTscan on GE's website.